Top 300 Pharmacy Drug Cards

PRAVASTATIN: Pravachol, Various

Class: HMG-CoA Reductase Inhibitor

Dosage Forms. Tablet: 10 mg, 20 mg, 40 mg, 80 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Cerebrovascular accident (prevention), coronary arteriosclerosis (primary or secondary prevention): 40 mg po daily

2. Familial hypercholesterolemia: Children 8-13 y, 20 mg po daily; Children 14-18 y, 40 mg po daily

3. Hyperlipidemia: Children (boys and postmenarchal girls) 10-17 y, 10 mg po daily, may titrate to 20 mg/d; Adults, 40 mg po daily, may titrate to 40-80 mg po daily

Off-Label Uses. None

MOA. HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol can decrease because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.

Drug Characteristics: Pravastatin

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Medication Safety Issues: Pravastatin

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Drug Interactions: Pravastatin

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Adverse Reactions: Pravastatin

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Efficacy Monitoring Parameters. Total cholesterol, LDL-cholesterol, and triglycerides levels; HDL-cholesterol levels.

Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue) or hepatotoxicity; LFTs should be performed at baseline, 12 wk after initiation of therapy, and every 6 mo thereafter; serum creatine kinase should be measured in patients experiencing muscle pain and in those receiving other drugs associated with myopathy.

Key Patient Counseling Points. Contact prescriber immediately if pregnancy occurs while taking pravastatin. Do not drink alcohol. Pravastatin does not take the place of diet and exercise to lower cholesterol levels.

Clinical Pearls. Lipid level assessment should be done within 4 wk following dose initiation or titration. Consider holding pravastatin 4-7 d before major surgery as patient is at higher risk for occurrence of rhabdomyolysis. May increase the risk of diabetes.